Universal Sompo Janta Personal Accident Insurance

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

Most general insurers and standalone health insurance companies provide personal accident covers in addition to their regular health insurance plans. Personal accident covers provide lump sum benefit against unexpected eventualities like accidental death or disability during the policy period. Universal Sompo Janta Personal Accident Insurance is a group personal accident policy offered by the insurer. Similar to individual personal accident covers, this policy does not provide coverage against the medical expenses incurred by the policyholder. The benefit obtained from this policy can be used for anything and there is no need to submit any expense bills or proofs.

Eligibility for Universal Sompo Janta Personal Accident Insurance

Those applying for Universal Sompo Janta Personal Accident Insurance must meet the following eligibility criteria:

• The proposer of the policy must be at least 18 years of age.
• The maximum entry age of this policy cover is capped at 65 years.
• Dependent children can be covered from the age of 5 years along with their parents.
• This policy is available for employees of an organisation or members of a specific group/association/club.

Features of Universal Sompo Janta Personal Accident Insurance

Universal Sompo Janta Personal Accident Insurance comes with the following set of features:

• Since this is a group cover, the maximum sum insured offered to a person varies based on the individual discretion of the company.
• Premium discounts are offered based on the number of members enrolled under a single policy cover. To avail this discount, at least 25 members must be enrolled in a policy cover.
• Up to 25% premium discount is available if the policy is taken for restricted hours when the insured person is on duty.
• Up to 50% premium discount is available if the policy is taken for restricted hours when the insured person is off duty.
• This policy cover is available for a term of 12 months.
• The premium amount for this policy is determined based on the number of group members, sum insured amount, extensions added to the cover, etc.
• Subject to approval from the Insurance Regulatory and Development Authority of India (IRDAI), the premium charges for this policy may be revised during the time of renewal.
• During the 15-day free look period offered under this policy, customers can review the terms and conditions and cancel the policy if they are not satisfied.

Benefits of Universal Sompo Janta Personal Accident Insurance

The benefits offered under this personal accident policy can be given in the following table:

Exclusions of Universal Sompo Janta Personal Accident Insurance

Some of the exclusions listed under Universal Sompo Janta Personal Accident Insurance can be listed as follows:

• Any medical expenses incurred due to accidental injuries
• Self-inflicted injuries, suicide, or attempted suicide
• Death or injuries caused by drug addiction or alcoholism
• Death or injuries caused while breaching the law with criminal intent
• Any loss due to war, invasion, civil unrest, mutiny, or revolution
• Illnesses or injuries caused by radioactive materials, toxic waste, or hazardous materials
• Sexually transmitted diseases and venereal diseases
• Death or disability caused by maternity, childbirth, or related complications
• Death or injuries caused while participating in adventure sports
• Expenses related to curative treatments or interventions

Claim Procedure

Death claim: Following the death of the insured person, the nominee or legal heir must file the claim request with the insurer within one calendar month of the event. While filing the death claim, the following documents must be submitted along with the claim form:

• Death certificate
• FIR copy
• Original panchnama
• Post mortem report

Once the documents are submitted, the company will verify the validity of the claim. The settlement amount will be provided after the verification.

Disability claim: Disability claims can be filed after a permanent disability caused by an accident. The disability may include permanent losses such as loss of eyesight or amputation of limbs following an accident. The claim must be filed within one month of the eventuality. While filing the claim, the following documents must be submitted to the insurer:

• Original FIR
• Panchnama
• Hospitalisation report
• Discharge summary
• Physician certificate

The company will verify the nature of the claim and provide the settlement amount after verification.

In both claims, the company will communicate the acceptance or rejection of the claim within 30 days after the receipt of the last necessary document. The settlement amount will be provided within 7 days from the date of acceptance.